Discordant patient–physician assessments of disease activity and its persistence adversely impact quality of life and work productivity in US Hispanics with rheumatoid arthritis

Karpouzas, George; Ramadan, Sera N; Cost, C; Draper, Taylor; Hernández, Elizabeth; Strand, Vibeke; Ormseth, Sarah R.

doi:10.1136/rmdopen-2017-000551

Cited by 17 publications

(57 citation statements)

References 37 publications

(39 reference statements)

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“…Numerous potential causes for this discordance have been identified, particularly pain due to inflammatory and non-inflammatory processes different from RA, fatigue, functional disability, depression, psychological stress, low health literacy, and patient-physician communication problems [6,9,10,26]. In the present study, fibromyalgia was not associated with discordance (negative or positive) between PtGA and PhGA, contrary to the findings of other studies [9,13,23]. This may be due to how this variable was obtained-by reviewing the medical records-, which may not be accurate to reflect the state of this comorbidity by the time of the interview.…”

Section: Plos Onecontrasting

confidence: 99%

“…This distance between points of view was also found in several other studies. In general, pain and/or physical function were associated with poorer patient assessment in the vast majority of studies [3,8,10,11,13,[23][24][25][26][27][28][29], whereas NSJ and/or abnormal acute inflammation tests were more frequent determinants of worse physician's assessments [8][9][10][11]13,26,27,29]. Numerous potential causes for this discordance have been identified, particularly pain due to inflammatory and non-inflammatory processes different from RA, fatigue, functional disability, depression, psychological stress, low health literacy, and patient-physician communication problems [6,9,10,26].…”

Section: Plos Onementioning

confidence: 99%

“…Longitudinal studies have shown a negative effect on health-related quality of life [13] and a greater impact on work productivity [6] among patients who persisted with worse disease activity scores than those of their physicians.…”

Section: Plos Onementioning

confidence: 99%

“…Understanding the reasons for the discrepancies between the PtGA and PhGA has become particularly important in the current context that defines remission as the treatment target [12]. Moreover, there is evidence suggesting that discordance is predictive of low health-related quality of life, loss of work productivity, and impaired functional capacity [6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Discordance between the patient’s and physician’s global assessment in rheumatoid arthritis: Data from the REAL study—Brazil

et al. 2020

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Background Discordance between patient's global assessment (PtGA) and physician's global assessment (PhGA) has been described in rheumatoid arthritis (RA). Understanding the reasons for this discrepancy is important in the context of treat-to-target treatment strategy. Objective To assess the determinants of PtGA and PhGA and factors associated with discordance between them. Methods The REAL study included RA patients from Brazilian public health centers. Clinical, laboratory and outcomes measures were collected. PtGA and the PhGA were rated on a visual analog scale and analyzed. Three groups were defined: no discordance (difference between PtGA and PhGA within 3 cm), positive discordance (PtGA exceeding PhGA by >3 cm), and

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Section: Plos Onecontrasting

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Discordance between the patient’s and physician’s global assessment in rheumatoid arthritis: Data from the REAL study—Brazil

et al. 2020

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“…The discordance between change in active joint count by physicians and change in PGA was found to be a negative predictor of achieving remission, which is the target of treatment in clinical practice . In rheumatoid arthritis, discordance was also reported to be associated with reduction in work productivity . Identifying factors associated with discordance may give insight to facilitate shared decision‐making, optimize treatment outcomes, reduce functional disability and reduce healthcare costs.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with patient‐physician discordance in a prospective cohort of patients with psoriatic arthritis: An Asian perspective

et al. 2019

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Objectives To evaluate factors associated with patient‐physician discordance in a multiethnic Asian cohort of psoriatic arthritis (PsA) patients. Methods We used data from a prospective cohort of consecutive patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis, recruited from a single center in Singapore. Sociodemographic, clinical data and patient‐reported outcomes were collected using a standardized protocol at baseline, 4 months, 8 months, 1 year, 2 years and 5 years. patient‐physician discordance was defined as patient global assessment minus physician global assessment (PGA‐PhGA). We evaluated variables associated with patient‐physician discordance using generalized linear regression to control for within‐subject effect. Results One hundred and fortytwo patients (51.4% male, 66.2% Chinese, mean [SD] age and duration of illness 51.1 [13.8] years and 27.5 [98.3] months) were recruited at baseline. Paired results for PGA and PhGA were available for 291 visits with median (interquartile range) follow‐up time of 11.6 (17) months. In univariable analysis, duration of illness, fatigue, pain, tender and swollen joint count, dactylitis count, and health‐related quality of life (Short Form‐36) domains were significantly correlated with patient‐physician discordance. In multivariable analysis, age, fatigue level, pain score were positively associated with patient‐physician discordance, while swollen joint count and mental health were negatively associated with patient physician discordance. Conclusions Increased age, higher fatigue levels, higher pain score and poorer mental health may explain underestimation of disease activity by physicians. Physicians’ overestimation of disease activity may be explained by higher swollen joint counts.

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Understanding Discordant Perceptions of Disease Severity Between Physicians and Patients With Eczema and Psoriasis Using Structural Equation Modeling

Long

Chan

et al. 2023

JAMA Dermatol

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ImportancePatients and physicians often have differing opinions on the patient’s disease severity. This phenomenon, termed discordant severity grading (DSG), hinders the patient-physician relationship and is a source of frustration.ObjectiveTo test and validate a model explaining the cognitive, behavioral, and disease factors associated with DSG.Design, Setting, and ParticipantsA qualitative study was first performed to derive a theoretical model. In this subsequent prospective cross-sectional quantitative study, the qualitatively derived theoretical model was validated using structural equation modeling (SEM). Recruitment was conducted between October 2021 and September 2022. This was a multicenter study in 3 Singapore outpatient tertiary dermatological centers. Dermatology patients and their attending physicians were recruited by convenience sampling. Patients were aged 18 to 99 years with psoriasis or eczema of at least 3 months’ duration and recruited only once. The data were analyzed between October 2022 to May 2023.Main Outcomes and MeasuresThe outcome was the difference between global disease severity (0-10 numerical rating scale with a higher score indicating greater severity) as independently scored by the patient and the dermatologist. Positive discordance was defined as patient-graded severity more than 2 points higher (graded more severely) than physicians, and negative discordance if more than 2 points lower than physicians. Confirmatory factor analysis followed by SEM was used to assess the associations between preidentified patient, physician, and disease factors with the difference in severity grading.ResultsOf the 1053 patients (mean [SD] age, 43.5 [17.5] years), a total of 579 (55.0%) patients were male, 802 (76.2%) had eczema, and 251 (23.8%) had psoriasis. Of 44 physicians recruited, 20 (45.5%) were male, 24 (54.5%) were aged between 31 and 40 years, 20 were senior residents or fellows, and 14 were consultants or attending physicians. The median (IQR) number of patients recruited per physician was 5 (2-18) patients. Of 1053 patient-physician pairs, 487 pairs (46.3%) demonstrated discordance (positive, 447 [42.4%]; negative, 40 [3.8%]). Agreement between patient and physician rating was poor (intraclass correlation, 0.27). The SEM analyses showed that positive discordance was associated with higher symptom expression (standardized coefficient B = 0.12; P = .02) and greater quality-of-life impairment (B = 0.31; P &lt; .001), but not patient or physician demographics. A higher quality-of-life impairment was in turn associated with lower resilience and stability (B = −0.23; P &lt; .001), increased negative social comparisons (B = 0.45; P &lt; .001), lower self-efficacy (B = −0.11; P = .02), increased disease cyclicity (B = 0.47; P &lt; .001), and greater expectation of chronicity (B = 0.18; P &lt; .001). The model was well-fitted (Tucker-Lewis: 0.94; Root Mean Square Error of Approximation: 0.034).Conclusions and RelevanceThis cross-sectional study identified various modifiable contributory factors to DSG, increased understanding of the phenomenon, and set a framework for targeted interventions to bridge this discordance.

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Discordant patient–physician assessments of disease activity and its persistence adversely impact quality of life and work productivity in US Hispanics with rheumatoid arthritis

Cited by 17 publications

References 37 publications

Discordance between the patient’s and physician’s global assessment in rheumatoid arthritis: Data from the REAL study—Brazil

Discordance between the patient’s and physician’s global assessment in rheumatoid arthritis: Data from the REAL study—Brazil

Factors associated with patient‐physician discordance in a prospective cohort of patients with psoriatic arthritis: An Asian perspective

Understanding Discordant Perceptions of Disease Severity Between Physicians and Patients With Eczema and Psoriasis Using Structural Equation Modeling

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